Beyond the checklist: Non-technical skills of the circulating nurse and their role in intraoperative patient safety

Résumé

Background: The circulating nurse is the perioperative team’s primary coordinator, patient advocate, and environmental safety manager during intraoperative care. However, the cognitive and social skills, collectively termed non-technical skills, that underpin safe circulating nursing practice have received substantially less scholarly and professional attention.

Purpose: This critical discussion paper examines the non-technical skills specific to the circulating nurse role, critically appraises the current evidence base, and advances implications for perioperative nursing education, practice, and quality improvement in Canadian operating rooms.

Discussion: Eight non-technical skills, namely communication, teamwork, situational awareness, leadership, task management, decision-making, escalation, and coping with stress and fatigue, have been identified across the available empirical literature. A recent scoping review confirmed these skills, but found the evidence base geographically narrow, dominated by studies from Europe and Asia, and the direct link to patient safety outcomes under-demonstrated. This paper argues that these skills are not supplementary to the circulating nurse’s role but integral to it, and that limited explicit attention to these skills in education and assessment may represent a missed opportunity to strengthen perioperative patient safety.

Conclusion: Canadian perioperative nurses, managers, and educators should give greater explicit attention to teaching, assessing, and supporting the non-technical skills of circulating nurses. ORNAC’s guidelines and perioperative nursing education programs provide the platform for this shift, and greater attention to these skills is warranted within Canadian perioperative education, practice, and research.